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the tympanic membrane may rupture. allowing the pus in the middle ear space to drain into the ear canal. It may result in bullous myringitis which means that the tympanic membrane and inflamed  In severe or untreated cases. frequently causing intense pain. When the middle ear becomes acutely infected. . pressure builds up behind the eardrum.

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 The use of a monocular otoscope and perhaps a tympanometer may not be able to distinguish bacterial versus viral etiology. especially if the canal is small and there is wax in the ear that obscures a clear view of the eardrum.  . Diagnosis Acute otitis media is usually diagnosed via visualization of the tympanic membrane in combination with the appropriate clinical history.

Evidence does not support zinc supplementation as an effort to reduce otitis rates except maybe in those with severe malnutrition such as marasmus. Prevention  Pneumococcal conjugate vaccines when given during infancy decrease rates of acute otitis media by 6–7% and if implemented broadly would have a significant public health benefit. .

Oral agents include ibuprofen. Decongestants and antihistamines. either nasal or oral. are not recommended due to the lack of benefit and concerns regarding side effects. Treatment Oral and topical analgesics are effective to treat the pain caused by otitis media.  .  Topical agents shown to be effective include antipyrine and benzocaine ear drops. paracetamol and narcotics.

Otitis media is most commonly caused by infection with viral. bacterial. or fungal pathogens.  The most common bacterial pathogen is Streptococcus pneumoniae  .